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Poplin T, Ironside M, Kuplicki R, Aupperle RL, Guinjoan SM, Khalsa SS, Stewart JL, Victor TA, Paulus MP, Kirlic N. The unique face of comorbid anxiety and depression: Increased frontal, insula and cingulate cortex response during Pavlovian fear-conditioning. J Affect Disord 2024; 366:98-105. [PMID: 39187192 DOI: 10.1016/j.jad.2024.08.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/03/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Dysregulation of fear processing through altered sensitivity to threat is thought to contribute to the development of anxiety disorders and major depressive disorder (MDD). However, fewer studies have examined fear processing in MDD than in anxiety disorders. The current study used propensity matching to examine the hypothesis that comorbid MDD and anxiety (AnxMDD) shows greater neural correlates of fear processing than MDD, suggesting that the co-occurrence of AnxMDD is exemplified by exaggerated defense related processes. METHODS 195 individuals with MDD (N = 65) or AnxMDD (N = 130) were recruited from the community and completed multi-level assessments, including a Pavlovian fear learning task during functional imaging. Visual images paired with threat (conditioned stimuli: CS+) were compared to stimuli not paired with threat (CS-). RESULTS MDD and AnxMDD showed significantly different patterns of activation for CS+ vs CS- in the dorsal anterior insula/inferior frontal gyrus (partial eta squared; ηp2 = 0.02), dorsolateral prefrontal cortex (ηp2 = 0.01) and dorsal anterior/mid cingulate cortex (ηp2 = 0.01). These differences were driven by greater activation to the CS+ in AnxMDD versus MDD. LIMITATIONS Limitations include the cross-sectional design, a scream US rather than shock and half the number of MDD as AnxMDD participants. CONCLUSIONS AnxMDD showed a pattern of increased activation in regions identified with fear processing. Effects were consistently driven by threat, further suggesting fear signaling as the emergent target process. Differences emerged in regions associated with salience processing, attentional orienting/conflict, self-relevant processing and executive functioning in comorbid anxiety and depression, thereby highlighting potential treatment targets for this prevalent and treatment resistant group.
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Affiliation(s)
- Tate Poplin
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Maria Ironside
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA.
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Robin L Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Salvador M Guinjoan
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Teresa A Victor
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA; University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
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Reilly EE, Wierenga CE, Grange DL. Testing the role of associative learning in evidence-based treatments for anorexia nervosa. Int J Eat Disord 2024; 57:1088-1095. [PMID: 38323377 PMCID: PMC11093706 DOI: 10.1002/eat.24161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
Treatments for anorexia nervosa (AN) remain ineffective for many patients. Processes that can account for differential treatment outcomes remain mostly unknown. We propose that the field test the role of associative learning in current psychological treatments. We hold that this line of research could yield actionable information for understanding non-response and improving long-term outcomes. To make this argument, we define associative learning and outline its proposed role in understanding psychiatric disorders and their treatment. We then briefly review data exploring associative learning in AN. We argue that associative learning processes are implicitly implicated in existing treatments; by this rationale, baseline differences in learning may interfere with treatment response. Finally, we outline future research to test our hypotheses. Altogether, future research aimed at better understanding how associative learning may contribute to AN symptom persistence has the potential to inform novel directions in intervention research. PUBLIC SIGNIFICANCE: There is a pressing need to improve outcomes in treatments for anorexia nervosa (AN). We propose that individual differences in associative learning-the ability to form and update associations between cues, contexts, behaviors, and outcomes-may account for differential response to existing treatments. Undertaking this research could provide an understanding of how current treatments work and inform new approaches for those who may be at risk of poor outcomes.
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Affiliation(s)
- Erin E. Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience (Emeritus), The University of Chicago, Chicago, Illinois, USA
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Mitchell BJ, Coifman KG, Olatunji BO. Is disgust more resistant to extinction than fear? A meta-analytic review of laboratory paradigms. Behav Res Ther 2024; 174:104479. [PMID: 38301293 DOI: 10.1016/j.brat.2024.104479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
Disgust can be acquired via evaluative conditioning; a process by which a neutral stimulus (conditioned stimulus; CS) comes to be evaluated as disgusting due to its pairing with an inherently disgusting stimulus (unconditioned stimulus; US). Research has shown that conditioned disgust responses are resistant to extinction which may have implications for disorders (i.e., contamination-based obsessive-compulsive disorder, specific phobias, and post-traumatic stress disorder) in which heightened disgust has been implicated. Importantly, extinction is the primary mechanism by which exposure therapies are thought to achieve symptom reduction for these disorders. Exposure therapies were originally modeled on fear extinction, whereas disgust extinction was largely overlooked until recently. Accordingly, differences in the degree to which learned disgust and fear can be attenuated via extinction learning remains unclear. The present investigation was a meta-analysis directly comparing the degree of extinction of conditioned disgust (n = 14) and conditioned fear (n = 14) in laboratory paradigms. Extinction was operationalized as the standardized mean difference (SMD) in evaluative ratings between the CS+ (the CS paired with the US) and CS- (the unpaired CS) after extinction training. Results of a subgroup analysis indicated that disgust (SMD = 0.52) was significantly more resistant to extinction than fear (SMD = 0.37). Additionally, a series of meta-regression analyses indicated that extinction was not influenced by important study characteristics (e.g., sex, age, number of conditioning and extinction trials). The findings suggest that extinction-based approaches may be less effective at attenuating learned disgust and research is needed to better optimize treatments for disgust-related disorders.
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Affiliation(s)
- Benjamin J Mitchell
- Department of Psychological Science, Kent State University, l, Kent, OH, United States.
| | - Karin G Coifman
- Department of Psychological Science, Kent State University, l, Kent, OH, United States
| | - Bunmi O Olatunji
- Psychological Sciences, Vanderbilt University, Nashville, TN, United States
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Klein Z, Shner-Livne G, Danon-Kraun S, Ginat-Frolich R, Pine DS, Shechner T. Enhanced late positive potential to conditioned threat cue during delayed extinction in anxious youth. J Child Psychol Psychiatry 2024; 65:215-228. [PMID: 37157184 DOI: 10.1111/jcpp.13814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Deficits in threat learning relate to anxiety symptoms. Since several anxiety disorders arise in adolescence, impaired adolescent threat learning could contribute to adolescent changes in risk for anxiety. This study compared threat learning among anxious and non-anxious youth using self-reports, peripheral psychophysiology measures, and event-related potentials. Because exposure therapy, the first-line treatment for anxiety disorders, is largely based on principles of extinction learning, the study also examined the link between extinction learning and treatment outcomes among anxious youth. METHODS Clinically anxious (n = 28) and non-anxious (n = 33) youth completed differential threat acquisition and immediate extinction. They returned to the lab a week later to complete a threat generalization test and a delayed extinction task. Following these two experimental visits, anxious youth received exposure therapy for 12 weeks. RESULTS Anxious as compared to non-anxious youth demonstrated elevated cognitive and physiological responses across acquisition and immediate extinction learning, as well as greater threat generalization. In addition, anxious youth showed enhanced late positive potential response to the conditioned threat cue compared to the safety cue during delayed extinction. Finally, aberrant neural response during delayed extinction was associated with poorer treatment outcomes. CONCLUSIONS The study emphasizes differences between anxious and non-anxious youth in threat learning processes and provides preliminary support for a link between neural processing during delayed extinction and exposure-based treatment outcome in pediatric anxiety.
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Affiliation(s)
- Zohar Klein
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Gil Shner-Livne
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Shani Danon-Kraun
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Rivkah Ginat-Frolich
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Daniel S Pine
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Tomer Shechner
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
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Kodzaga I, Dere E, Zlomuzica A. Generalization of beneficial exposure effects to untreated stimuli from another fear category. Transl Psychiatry 2023; 13:401. [PMID: 38114494 PMCID: PMC10730830 DOI: 10.1038/s41398-023-02698-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Previous research has shown that fear associated with one stimulus often spreads to other stimuli with similar perceptual features as well as across different stimulus categories. Exposure is considered as the most effective intervention to attenuate exaggerated fear. The extent to which exposure treatment effects can generalize to fears not targeted during treatment remains elusive. Previous studies on possible generalization of beneficial effects of exposure used stimuli sharing the same stimulus category and/or stimuli having high perceptual similarity. The current study examined whether exposure treatment generalization can be achieved for untreated stimuli which do not share any perceptual resemblance and belong to a different fear category. An analogue sample of fifty participants with fear of spiders (animal-related fears) and heights (natural environment-related fears) was tested. Participants have been randomly assigned to either an exposure treatment (n = 24) or a control condition (n = 26). Exposure treatment was designed to only target participants' fear of spiders, leaving their fear of heights untreated. Results demonstrated that the effects of exposure treatment generalized to fear of heights, as indicated by a reduction in behavioral avoidance, as well as self-reported acrophobia symptoms. The present study confutes the assumption that generalization of exposure effects to untreated fears is based on perceptual similarity. Clearly, further research is required to determine the decisive factors, in order to expand the generalization effect permanently to any given type of fear.
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Affiliation(s)
- Iris Kodzaga
- Department of Behavioral and Clinical Neuroscience, Ruhr-University Bochum (RUB), D-44787, Bochum, Germany
| | - Ekrem Dere
- Department of Behavioral and Clinical Neuroscience, Ruhr-University Bochum (RUB), D-44787, Bochum, Germany
- Sorbonne Université. UFR des Sciences de la Vie, F-75005, Paris, France
| | - Armin Zlomuzica
- Department of Behavioral and Clinical Neuroscience, Ruhr-University Bochum (RUB), D-44787, Bochum, Germany.
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Adams TG, Kelmendi B, George JR, Forte J, Hubert TJJ, Wild H, Rippey CS, Pittenger C. Frontopolar multifocal transcranial direct current stimulation reduces conditioned fear reactivity during extinction training: A pilot randomized controlled trial. Neurobiol Learn Mem 2023; 205:107825. [PMID: 37699439 PMCID: PMC10872945 DOI: 10.1016/j.nlm.2023.107825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/16/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
Exposure-based therapies for anxiety and related disorders are believed to depend on fear extinction learning and corresponding changes in extinction circuitry. Frontopolar multifocal transcranial direct current stimulation (tDCS) has been shown to improve therapeutic safety learning during in vivo exposure and may modulate functional connectivity of networks implicated in fear processing and inhibition. A pilot randomized controlled trial was completed to determine the effects of frontopolar tDCS on extinction learning and memory. Community volunteers (n = 35) completed a 3-day fear extinction paradigm with measurement of electrodermal activity. Participants were randomized (single-blind) to 20-min of sham (n = 17, 30 s. ramp in/out) or active (n = 18) frontopolar (anode over Fpz, 10-10 EEG) multifocal tDCS (20-min, 1.5 mA) prior to extinction training. Mixed ANOVAs revealed a significant group*trial effect on skin conductance response (SCR) to the conditioned stimulus (CS + ) during extinction training (p = 0.007, Cohen's d = 0.55). The effects of frontopolar tDCS were greatest during the first two extinction trials, suggesting that tDCS may have promoted fear inhibition prior to safety learning. Return of fear to the CS + during tests were comparable across conditions (ps > 0.50). These findings suggest that frontopolar tDCS may modulate the processing of threat cues and associated circuitry or promote the inhibition of fear. This has clear implications for the treatment of anxiety and related disorders with therapeutic exposure.
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Affiliation(s)
- Thomas G Adams
- Department of Psychology, University of Kentucky, United States; Department of Psychiatry, Yale University School of Medicine, United States.
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, United States; Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, United States
| | - Jamilah R George
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychological Sciences, University of Connecticut, United States
| | - Jennifer Forte
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychology, Binghamton University, United States
| | - Troy J J Hubert
- Department of Psychology, University of Kentucky, United States
| | - Hannah Wild
- Department of Psychology, University of Kentucky, United States
| | - Colton S Rippey
- Department of Psychology, University of Kentucky, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, United States; Child Study Center, Yale University, United States; Department of Psychology, Center for Brain and Mind Health, Yale University, United States
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Poplin T, Ironside M, Kuplicki R, Aupperle RL, Guinjoan SM, Khalsa SS, Stewart JL, Victor TA, Paulus MP, Kirlic N. The unique face of anxious depression: Increased sustained threat circuitry response during fear acquisition. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.17.562565. [PMID: 37905149 PMCID: PMC10614928 DOI: 10.1101/2023.10.17.562565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background Sensitivity to threat with dysregulation of fear learning is thought to contribute to the development of psychiatric disorders, including anxiety disorders (AD) and major depressive disorder (MDD). However, fewer studies have examined fear learning in MDD than in AD. Nearly half of individuals with MDD have an AD and the comorbid diagnosis has worse outcomes. The current study used propensity matching to examine the hypothesis that AD+MDD shows greater neural correlates of fear learning than MDD, suggesting that the co-occurrence of AD+MDD is exemplified by exaggerated defense related processes. Methods 195 individuals with MDD (N = 65) or AD+MDD (N=130) were recruited from the community and completed multi-level assessments, including a Pavlovian fear learning task during functional imaging. Results MDD and AD+MDD showed significantly different patterns of activation for [CSplus-CSminus] in the medial amygdala (ηp2=0.009), anterior insula (ηp2=0.01), dorsolateral prefrontal cortex (ηp2=0.002), dorsal anterior cingulate cortex (ηp2=0.01), mid-cingulate cortex (ηp2=0.01) and posterior cingulate cortex (ηp2=0.02). These differences were driven by greater activation to the CS+ in late conditioning phases in ADD+MDD relative to MDD. Conclusions AD+MDD showed a pattern of increased sustained activation in regions identified with fear learning. Effects were consistently driven by the threat condition, further suggesting fear signaling as the emergent target process. Differences emerged in regions associated with salience processing, attentional orienting/conflict, and self-relevant processing.These findings help to elucidate the fear signaling mechanisms involved in the pathophysiology of comorbid anxiety and depression, thereby highlighting promising treatment targets for this prevalent treatment group.
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Affiliation(s)
- Tate Poplin
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Maria Ironside
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Robin L. Aupperle
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Salvador M. Guinjoan
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Jennifer L. Stewart
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Teresa A. Victor
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
- University of Tulsa, 800 South Tucker Drive, Tulsa, OK 74104, USA
| | - Namik Kirlic
- Laureate Institute for Brain Research, 6655 South Yale Avenue, Tulsa, OK 74136, USA
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Zilcha-Mano S, Duek O, Suarez-Jimenez B, Zhu X, Lazarov A, Helpman L, Korem N, Malka M, Harpaz-Rotem I, Neria Y. Underlying Hippocampal Mechanism of Posttraumatic Stress Disorder Treatment Outcome: Evidence From Two Clinical Trials. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:867-874. [PMID: 37881552 PMCID: PMC10593870 DOI: 10.1016/j.bpsgos.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/12/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background The hippocampus plays an important role in the pathophysiology of posttraumatic stress disorder (PTSD) and its prognosis. Accumulating findings suggest that individuals with larger pretreatment hippocampal volume are more likely to benefit from PTSD treatment, but the mechanism underlying this effect is unknown. We investigated whether further increase in hippocampal volume during treatment explains the better prognosis of individuals with greater pretreatment hippocampal volume. Methods We collected structural magnetic resonance imagesfrom patients with PTSD before and after treatment. We examined whether larger hippocampal volume moderates the effect of increased hippocampal volume during treatment on symptom reduction. Given the relatively small sample sizes of treatment studies with pre- and posttreatment magnetic resonance imaging, we focused on effect sizes and sought to replicate findings in an external sample. We tested our hypothesis in study 1 (N = 38; prolonged exposure therapy) and then tested whether the results could be externally replicated in study 2 (N = 20; ketamine infusion followed by exposure therapy). Results Findings from study 1 revealed that increased right hippocampal volume during treatment was associated with greater PTSD symptom reduction only in patients with greater pretreatment right hippocampal volume (p = .03; η2 = 0.13, a large effect). Findings were partially replicated in study 2 for depressive symptoms (p = .034; η2 = 0.25, a very large effect) and for PTSD symptoms (p = .15; η2 = 0.15, a large effect). Conclusions Elucidating increased hippocampal volume as one of the neural mechanisms predictive of therapeutic outcome for individuals with larger pretreatment hippocampal volume may help identify clinical targets for this subgroup.
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Affiliation(s)
| | - Or Duek
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | | | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
| | - Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Liat Helpman
- Department of Counseling and Human Development, University of Haifa, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nachshon Korem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- National Center for PTSD, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Michal Malka
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- National Center for PTSD, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
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Caudle MM, Dugas N, Stout DM, Ball TM, Bomyea J. Adjunctive cognitive training with exposure enhances fear and neural outcomes in social anxiety. Psychiatry Res 2023; 327:115416. [PMID: 37604041 DOI: 10.1016/j.psychres.2023.115416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success.
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Affiliation(s)
- M M Caudle
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States; Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - N Dugas
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - D M Stout
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - T M Ball
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, 401 Quarry Road, Stanford, CA, 94305, United States
| | - J Bomyea
- Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States.
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Lubin RE, Fitzgerald HE, Rosenfield D, Carpenter JK, Papini S, Dutcher CD, Dowd SM, Hofmann SG, Pollack MH, Smits JAJ, Otto MW. Using pre-treatment de novo threat conditioning outcomes to predict treatment response to DCS augmentation of exposure-based CBT. J Psychiatr Res 2023; 164:357-363. [PMID: 37399757 PMCID: PMC10557473 DOI: 10.1016/j.jpsychires.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Over a decade and a half of research has resulted in inconsistent evidence for the efficacy of d-cycloserine (DCS), a partial glutamatergic N-methyl-D-aspartate agonist, for augmenting exposure-based cognitive behavioral therapy (CBT) for anxiety- and fear-based disorders. These variable findings have motivated the search for moderators of DCS augmentation efficacy. METHODS In this secondary analysis of a previous randomized clinical trial, we evaluated the value of de novo threat conditioning outcomes-degree of threat acquisition, extinction, and extinction retention-for predicting treatment response to exposure-based CBT for social anxiety disorder, applied with and without DCS augmentation in a sample of 59 outpatients. RESULTS We found that average differential skin conductance response (SCR) during extinction and extinction retention significantly moderated the prediction of clinical response to DCS: participants with poorer extinction and extinction retention showed relatively improved treatment response with DCS. No such effects were found for expectancy ratings, consistent with accounts of DCS selectively aiding lower-order but not higher-order extinction learning. CONCLUSIONS These findings provide support for extinction and extinction retention outcomes from threat conditioning as potential pre-treatment biomarkers for DCS augmentation benefits. Independent of DCS augmentation, the current study did not support threat conditioning outcomes as useful for predicting response to exposure-based CBT.
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Affiliation(s)
- Rebecca E Lubin
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Fl, Boston, MA, 02215, USA.
| | - Hayley E Fitzgerald
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Fl, Boston, MA, 02215, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, 6116 North Central Expressway, Dallas, TX, 75206, USA
| | - Joseph K Carpenter
- National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division, 150 S Huntington Ave, Boston, MA, 02130, USA; VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - Santiago Papini
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Christina D Dutcher
- Institute of Mental Health Research and Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Sheila M Dowd
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd Suite 400, Chicago, IL, 60612, USA
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps University Marburg, Schulstrasse 12, 35037, Marburg/Lahn, Germany
| | - Mark H Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd Suite 400, Chicago, IL, 60612, USA; Sage Therapeutics, 215 First St, Cambridge, MA, 02142, USA
| | - Jasper A J Smits
- Institute of Mental Health Research and Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Fl, Boston, MA, 02215, USA
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11
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Lipp A, Macit B, Woud ML, Dere E, Zlomuzica A. Conscious knowledge of CS-UCS contingency information affects extinction retrieval of conditioned disgust responses: Findings from an online de novo disgust conditioning task. Int J Clin Health Psychol 2023; 23:100368. [PMID: 36762035 PMCID: PMC9883280 DOI: 10.1016/j.ijchp.2023.100368] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Objective The present study aimed to establish and develop an online de novo conditioning paradigm for the measurement of conditioned disgust responses. We further explored the effects of explicit instructions about the CS-UCS contingency on extinction learning and retrieval of conditioned disgust responses. Method The study included a sample of 115 healthy participants. Geometric figures served as conditioned stimuli (CS) and disgust-evoking pictures as unconditioned stimuli (UCS). During disgust conditioning, the CS+ was paired with the UCS (66% reinforcement) and the CS- remained unpaired; during extinction and retrieval, no UCS was presented. Half of the participants (n = 54) received instructions prior to the disgust extinction stating that the UCS will not be presented anymore. 1-2 days or 7-8 days later participants performed a retrieval test. CS-UCS contingency, disgust and valence ratings were used as dependent measures. Results Successful acquisition of conditioned disgust response was observed on the level of CS-UCS contingency, disgust and valence ratings. While some decline in valence and disgust ratings during the extinction stage was observed, contingency instructions did not significantly affect extinction performance. Retrieval one week later revealed that contingency instructions increased the discrimination of the CSs. Conclusions Extinction of conditioned disgust responses is not affected by explicit knowledge of the CS-UCS contingencies. However, contingency instructions prior to extinction seem to have a detrimental effect on long-term extinction retrieval.
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Affiliation(s)
- Annalisa Lipp
- Department of Behavioral and Clinical Neuroscience, Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Germany
| | - Beray Macit
- Department of Behavioral and Clinical Neuroscience, Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Germany
| | - Marcella L. Woud
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Germany
| | - Ekrem Dere
- Department of Behavioral and Clinical Neuroscience, Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Armin Zlomuzica
- Department of Behavioral and Clinical Neuroscience, Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
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12
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Beckers T, Hermans D, Lange I, Luyten L, Scheveneels S, Vervliet B. Understanding clinical fear and anxiety through the lens of human fear conditioning. NATURE REVIEWS PSYCHOLOGY 2023; 2:233-245. [PMID: 36811021 PMCID: PMC9933844 DOI: 10.1038/s44159-023-00156-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/18/2023]
Abstract
Fear is an adaptive emotion that mobilizes defensive resources upon confrontation with danger. However, fear becomes maladaptive and can give rise to the development of clinical anxiety when it exceeds the degree of threat, generalizes broadly across stimuli and contexts, persists after the danger is gone or promotes excessive avoidance behaviour. Pavlovian fear conditioning has been the prime research instrument that has led to substantial progress in understanding the multi-faceted psychological and neurobiological mechanisms of fear in past decades. In this Perspective, we suggest that fruitful use of Pavlovian fear conditioning as a laboratory model of clinical anxiety requires moving beyond the study of fear acquisition to associated fear conditioning phenomena: fear extinction, generalization of conditioned fear and fearful avoidance. Understanding individual differences in each of these phenomena, not only in isolation but also in how they interact, will further strengthen the external validity of the fear conditioning model as a tool with which to study maladaptive fear as it manifests in clinical anxiety.
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Affiliation(s)
- Tom Beckers
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Dirk Hermans
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Iris Lange
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Laura Luyten
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Sara Scheveneels
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Bram Vervliet
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Leuven Brain Institute, KU Leuven, Leuven, Belgium
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13
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Fritz EM, Pierre A, De Bundel D, Singewald N. Ghrelin receptor agonist MK0677 and overnight fasting do not rescue deficient fear extinction in 129S1/SvImJ mice. Front Psychiatry 2023; 14:1094948. [PMID: 36846243 PMCID: PMC9947350 DOI: 10.3389/fpsyt.2023.1094948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023] Open
Abstract
The hunger hormone ghrelin has been implicated in the modulation of anxiety- and fear-related behaviors in rodents and humans, while its dysregulation may be associated with psychiatric illness. Along these lines, the ghrelin system has been suggested as a potential target to facilitate fear extinction, which is the main mechanism underlying cognitive behavioral therapy. So far, this hypothesis has not been tested in individuals that have difficulties to extinguish fear. Thus, we investigated pharmacological (ghrelin receptor agonist MK0677) and non-pharmacological (overnight fasting) strategies to target the ghrelin system in the 129S1/SvImJ (S1) mouse strain, which models the endophenotype of impaired fear extinction that has been associated with treatment resistance in anxiety and PTSD patients. MK0677 induced food intake and overnight fasting increased plasma ghrelin levels in S1 mice, suggesting that the ghrelin system is responsive in the S1 strain. However, neither systemic administration of MK0677 nor overnight fasting had an effect on fear extinction in S1 mice. Similarly, our groups previously reported that both interventions did not attenuate fear in extinction-competent C57BL/6J mice. In summary, our findings are in contrast to several studies reporting beneficial effects of GHSR agonism and overnight fasting on fear- and anxiety-related behaviors in rodents. Rather, our data agree with accumulating evidence of divergent behavioral effects of ghrelin system activation and underscore the hypothesis that potential benefits of targeting the ghrelin system in fear extinction may be dependent on factors (e.g., previous stress exposure) that are not yet fully understood.
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Affiliation(s)
- Eva Maria Fritz
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Innsbruck, Austria
| | - Anouk Pierre
- Department of Pharmaceutical Sciences, Research Group Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Dimitri De Bundel
- Department of Pharmaceutical Sciences, Research Group Experimental Pharmacology, Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Innsbruck, Austria
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14
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Fear conditioning and extinction learning in the mood and anxiety disorders spectrum - Associations with the outcome of cognitive behavior therapy. Behav Res Ther 2023; 160:104229. [PMID: 36463833 DOI: 10.1016/j.brat.2022.104229] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
In the current study, we test for the specificity of deficits in fear acquisition and extinction for the anxiety disorders spectrum. We compared fear acquisition and fear extinction learning between a group of patients with either an anxiety disorder (n = 93) or depression (n = 103) attending for treatment in our outpatient center and a sample of healthy control participants (n = 60). To assess the specificity of the predictive validity of extinction learning and safety learning for the outcome of exposure-based treatments, patients additionally underwent disorder-specific cognitive behavior therapy (CBT). We found only very little evidence for differences in safety or extinction learning between healthy controls and patients with anxiety-disorders or depression using both a group-based categorical analytic approach, as well as a trans-diagnostic, dimensional analytic approach. On the contrary, for anxiety patients only, more favorable extinction learning and more favorable safety learning was associated with more favorable treatment outcome. In sum, this specific prediction of treatment outcome in anxiety patients confirms and extends current theoretical models of exposure-based treatments for anxiety disorders, but does not support the notion of general extinction learning deficits in the anxiety disorders spectrum.
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15
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Huang J, Xu F, Yang L, Tuolihong L, Wang X, Du Z, Zhang Y, Yin X, Li Y, Lu K, Wang W. Involvement of the GABAergic system in PTSD and its therapeutic significance. Front Mol Neurosci 2023; 16:1052288. [PMID: 36818657 PMCID: PMC9928765 DOI: 10.3389/fnmol.2023.1052288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
The neurobiological mechanism of post-traumatic stress disorder (PTSD) is poorly understood. The inhibition of GABA neurons, especially in the amygdala, is crucial for the precise regulation of the consolidation, expression, and extinction of fear conditioning. The GABAergic system is involved in the pathophysiological process of PTSD, with several studies demonstrating that the function of the GABAergic system decreases in PTSD patients. This paper reviews the preclinical and clinical studies, neuroimaging techniques, and pharmacological studies of the GABAergic system in PTSD and summarizes the role of the GABAergic system in PTSD. Understanding the role of the GABAergic system in PTSD and searching for new drug targets will be helpful in the treatment of PTSD.
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Affiliation(s)
| | - Fei Xu
- Department of Psychiatry of School of Public Health, Southern Medical University, Guangzhou, China
| | - Liping Yang
- Department of Applied Psychology of School of Public Health, Southern Medical University, Guangzhou, China
| | - Lina Tuolihong
- Department of Basic Medical of Basic Medical College, Southern Medical University, Guangzhou, China
| | - Xiaoyu Wang
- Eight-Year Master's and Doctoral Program in Clinical Medicine of the First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Zibo Du
- Eight-Year Master's and Doctoral Program in Clinical Medicine of the First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yiqi Zhang
- Eight-Year Master's and Doctoral Program in Clinical Medicine of the First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Xuanlin Yin
- Department of Basic Medical of Basic Medical College, Southern Medical University, Guangzhou, China
| | - Yingjun Li
- Department of Medical Laboratory Science, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Kangrong Lu
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, Southern Medical University, Guangzhou, China
| | - Wanshan Wang
- Department of Laboratory Animal Center, Southern Medical University, Guangzhou, China
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16
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Smits JAJ, Monfils MH, Otto MW, Telch MJ, Shumake J, Feinstein JS, Khalsa SS, Cobb AR, Parsons EM, Long LJ, McSpadden B, Johnson D, Greenberg A. CO 2 reactivity as a biomarker of exposure-based therapy non-response: study protocol. BMC Psychiatry 2022; 22:831. [PMID: 36575425 PMCID: PMC9793569 DOI: 10.1186/s12888-022-04478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Exposure-based therapy is an effective first-line treatment for anxiety-, obsessive-compulsive, and trauma- and stressor-related disorders; however, many patients do not improve, resulting in prolonged suffering and poorly used resources. Basic research on fear extinction may inform the development of a biomarker for the selection of exposure-based therapy. Growing evidence links orexin system activity to deficits in fear extinction and we have demonstrated that reactivity to an inhaled carbon dioxide (CO2) challenge-a safe, affordable, and easy-to-implement procedure-can serve as a proxy for orexin system activity and predicts fear extinction deficits in rodents. Building upon this basic research, the goal for the proposed study is to validate CO2 reactivity as a biomarker of exposure-based therapy non-response. METHODS We will assess CO2 reactivity in 600 adults meeting criteria for one or more fear- or anxiety-related disorders prior to providing open exposure-based therapy. By incorporating CO2 reactivity into a multivariate model predicting treatment non-response that also includes reactivity to hyperventilation as well as a number of related predictor variables, we will establish the mechanistic specificity and the additive predictive utility of the potential CO2 reactivity biomarker. By developing models independently within two study sites (University of Texas at Austin and Boston University) and predicting the other site's data, we will validate that the results are likely to generalize to future clinical samples. DISCUSSION Representing a necessary stage in translating basic research, this investigation addresses an important public health issue by testing an accessible clinical assessment strategy that may lead to a more effective treatment selection (personalized medicine) for patients with anxiety- and fear-related disorders, and enhanced understanding of the mechanisms governing exposure-based therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05467683 (20/07/2022).
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Affiliation(s)
- Jasper A. J. Smits
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Marie-H. Monfils
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Michael W. Otto
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Michael J. Telch
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Jason Shumake
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Justin S. Feinstein
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Sahib S. Khalsa
- grid.417423.70000 0004 0512 88633The Laureate Institute for Brain Research, 6655 South Yale Ave., Tulsa, Oklahoma 74136 USA
| | - Adam R. Cobb
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA ,grid.259828.c0000 0001 2189 3475Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina and Ralph H. Johnson VAHCS, 67 President Street MSC 862, Charleston, SC 29425 USA
| | - E. Marie Parsons
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Laura J. Long
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
| | - Bryan McSpadden
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - David Johnson
- grid.89336.370000 0004 1936 9924Department of Psychology and Institute for Mental Health Research, University of Texas at Austin, 1 University Station, Austin, TX 78712 USA
| | - Alma Greenberg
- grid.189504.10000 0004 1936 7558Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Floor 2, Boston, MA 02215 USA
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17
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Cooper SE, Dunsmoor JE, Koval KA, Pino ER, Steinman SA. Test–retest
reliability of human threat conditioning and generalization across a
1‐to‐2‐week
interval. Psychophysiology 2022; 60:e14242. [PMID: 36546410 DOI: 10.1111/psyp.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Given the increasing use of threat conditioning and generalization for clinical-translational research efforts, establishing test-retest reliability of these paradigms is necessary. Specifically, it is an empirical question whether the same participant evinces a similar generalization gradient of conditioned responses across two sessions with the identical contingencies and stimuli. Here, 46 human volunteers participated in an identical auditory threat acquisition and generalization protocol at two sessions separated by 1-to-2 weeks. Skin conductance responses (SCR) and trial-by-trial shock risk ratings served as primary measures. We used linear mixed effects modeling to test differential threat responses and generalization gradients, and Generalizability (G) theory coefficients as our primary formal assessment of test-retest reliability of intraindividual stability and change across time. Results showed largely invariant differential conditioning and generalization gradients across time. G coefficients indicated fair reliability for acquisition and generalization SCR. In contrast, risk rating reliabilities were mixed, and reliability was particularly low for acquisition risk ratings. Our findings generally support reliability of the threat conditioning and generalization paradigm for shorter test-retest intervals and highlight their utility for assessments of behavioral interventions in mental health research, but challenges remain and further work is needed. Threat conditioning and generalization tasks are increasingly used for translational efforts to improve behavioral interventions, and thus test-retest reliability for these tasks needs to be established. Our results support the test-retest reliability of threat conditioning and generalization over a relatively short (1-to-2 week) interval, but this depends on the measure used (physiological vs. self-report). Overall, these tasks could be appropriate for repeated testing over the course of a short-duration intervention study, but more research is needed, particularly in regard to longer-duration studies.
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Affiliation(s)
- Samuel E. Cooper
- Department of Psychiatry and Behavioral Sciences University of Texas at Austin Austin Texas USA
| | - Joseph E. Dunsmoor
- Department of Psychiatry and Behavioral Sciences University of Texas at Austin Austin Texas USA
- Institute for Neuroscience University of Texas at Austin Austin Texas USA
| | - Kathleen A. Koval
- Department of Psychology West Virginia University Morgantown West Virginia USA
| | - Emma R. Pino
- Department of Psychology West Virginia University Morgantown West Virginia USA
| | - Shari A. Steinman
- Department of Psychology West Virginia University Morgantown West Virginia USA
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18
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Knowles KA, Tolin DF. Mechanisms of Action in Exposure Therapy. Curr Psychiatry Rep 2022; 24:861-869. [PMID: 36399234 DOI: 10.1007/s11920-022-01391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW Exposure therapy is an effective treatment for anxiety-related disorders, but many individuals do not achieve full symptom relief, and return of fear is a common occurrence. Understanding how exposure therapy works enables further development of strategies to improve its effectiveness. RECENT FINDINGS Recent studies have examined mechanisms of exposure-based interventions across multiple levels of analysis, from cognitive and behavioral changes that occur during treatment to the neurobiological mechanisms underlying fear extinction. Belief change and reductions in safety behaviors and avoidance mediate symptom improvements during exposure therapy, suggesting plausible cognitive and behavioral mechanisms. On the neural level, increased activation of prefrontal regions during extinction learning is a likely mechanism of exposure. Improved understanding of the biological mechanisms of exposure have led to exciting developments in clinical research, including pharmacological augmentation, though clinical translation of basic research has produced mixed results. Though still in development, such translational research is a promising future direction for exposure-based interventions.
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Affiliation(s)
- Kelly A Knowles
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - David F Tolin
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA. .,Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
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19
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Graham BM. The impact of hormonal contraceptives on anxiety treatments: From preclinical models to clinical settings. Front Neuroendocrinol 2022; 67:101030. [PMID: 35995079 DOI: 10.1016/j.yfrne.2022.101030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/10/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022]
Abstract
Exposure therapy is a central component of the first-line treatment for anxiety disorders, a common mental health condition that is twice as prevalent in women relative to men. A key underlying mechanism of exposure therapy is fear extinction, which is an active learning process supported by a neural circuitry that is highly regulated by ovarian hormones. This review synthesises research examining the impact of hormonal contraceptives on laboratory fear extinction tasks in female rats and women, and on exposure therapy in women with anxiety disorders. The evidence indicates that hormonal contraceptives have a detrimental impact on fear extinction and exposure therapy that is consistent across species, and from laboratory to clinical settings. Candidate pathways by which hormonal contraceptives impede fear extinction and exposure therapy include suppression of endogenous ovarian hormones and glucocorticoids, and downregulation of signalling pathways that support extinction learning. Key areas of focus for future research are discussed.
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Affiliation(s)
- Bronwyn M Graham
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, Australia.
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20
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Khalsa SS, Victor TA, Kuplicki R, Yeh HW, Vanover KE, Paulus MP, Davis RE. Single doses of a highly selective inhibitor of phosphodiesterase 1 (lenrispodun) in healthy volunteers: a randomized pharmaco-fMRI clinical trial. Neuropsychopharmacology 2022; 47:1844-1853. [PMID: 35488084 PMCID: PMC9372139 DOI: 10.1038/s41386-022-01331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Abstract
Lenrispodun is a potent and highly selective inhibitor of phosphodiesterase (PDE) type 1, which is thought to prolong intracellular second messenger signaling within cortical and subcortical dopaminergic brain regions. This is the first study of a PDE1 inhibitor in healthy volunteers using behavioral and neuroimaging approaches to examine its effects on neural targets and to provide a safety and tolerability assessment. The primary objectives were to determine whether lenrispodun induces changes in BOLD fMRI signals in the inferior frontal gyrus (IFG) during the stop signal task, and the dorsal anterior insula (dAI) during the extinction phase of a fear conditioning/extinction task. Using a double-blind, placebo-controlled, within-subjects design, 26 healthy individuals (22 completed all fMRI sessions) received in random order a single oral dose of placebo, lenrispodun 1.0 milligram (mg) or lenrispodun 10.0 mg and completed several tasks in the scanner including the stop signal (n = 24) and fear conditioning/extinction tasks (n = 22). Prespecified region-of-interest analyses for the IFG and dAI were computed using linear mixed models. Lenrispodun induced increases in IFG activity during the stop signal task at 1.0 mg (Cohen's d = 0.63) but not 10.0 mg (Cohen's d = 0.07) vs. placebo. Lenrispodun did not induce changes in dAI activity during fear extinction at either dose. Exploratory outcomes revealed changes in cardiac interoception. Lenrispodun administration was well-tolerated. These results provide evidence that 1.0 mg lenrispodun selectively improved neural inhibitory control without altering fear extinction processing. Future investigations should determine whether lenrispodun improves inhibitory control in target populations such as individuals with attention deficit hyperactivity disorder. Trial registration: ClinicalTrials.gov identifier: NCT03489772.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, USA.
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA.
| | | | | | - Hung-Wen Yeh
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
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21
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Vizeli P, Straumann I, Duthaler U, Varghese N, Eckert A, Paulus MP, Risbrough V, Liechti ME. Effects of 3,4-Methylenedioxymethamphetamine on Conditioned Fear Extinction and Retention in a Crossover Study in Healthy Subjects. Front Pharmacol 2022; 13:906639. [PMID: 35910354 PMCID: PMC9326355 DOI: 10.3389/fphar.2022.906639] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background: 3,4-Methylenedioxymethamphetamine (MDMA) has shown initial promise as an adjunct in psychotherapy to treat posttraumatic stress disorder (PTSD). Its efficacy and safety have been demonstrated across phase I-III studies. However, the mechanism underlying the potential utility of MDMA to treat PTSD in humans has not yet been thoroughly investigated. Preliminary evidence suggests that MDMA may facilitate fear extinction recall, which may be through the release of oxytocin. To test this hypothesis, we examined the efficacy of acute MDMA treatment to enhance fear extinction learning and recall. Methods: We used a two-period, double-blind, randomized, placebo-controlled crossover design in 30 healthy male subjects who received a placebo and a single dose of MDMA (125 mg). Fear extinction was tested using two separate Pavlovian fear conditioning paradigms, one using skin conductance response (SCR), and the other fear-potentiated startle (FPS) to conditioned cues. MDMA treatment occurred after fear conditioning and 2 h before extinction learning. Extinction recall was tested 23 h after MDMA intake. Additional outcome measures included subjective effects, emotion recognition tasks, plasma levels of oxytocin, and pharmacokinetics. Results: Fear conditioning and extinction learning were successful in both fear extinction paradigms (generalized eta-squared [ges] for SCR: 0.08; FPS: 0.07). Compared to placebo treatment, MDMA treatment significantly reduced SCRs to the reinforced conditioned stimulus (CS+) during extinction learning (ges = 0.03) and recall (ges = 0.06). Intensity of the subjective effects of MDMA (good effect, trust, and openness) during extinction learning negatively correlated with the discrimination between CS+ and the safety stimulus (CS-) during recall. MDMA did not influence FPS to conditioned cues. Oxytocin concentration was increased fourfold on average by MDMA during acute effects but was not associated with fear extinction outcomes. Conclusions: MDMA treatment facilitated rapid fear extinction and retention of extinction as measured by SCR to fear cues, in line with animal studies of MDMA facilitation of extinction. However, this effect may be limited to certain forms of learned fear responses, as it was not observed in the extinction model using startle reactivity as the outcome. This study provides further evidence for the facilitation of extinction with MDMA treatment and suggests this may be a component of its efficacy when paired with psychotherapy. Clinical Trial registration: clinicaltrials.gov identifier: NCT03527316.
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Affiliation(s)
- Patrick Vizeli
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,*Correspondence: Patrick Vizeli, ; Matthias E. Liechti,
| | - Isabelle Straumann
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Urs Duthaler
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Nimmy Varghese
- Psychiatric University Hospital, University of Basel, Basel, Switzerland,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Anne Eckert
- Psychiatric University Hospital, University of Basel, Basel, Switzerland,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | | | - Victoria Risbrough
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Center of Excellence for Stress and Mental Health, San Diego, CA, United States
| | - Matthias E. Liechti
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland,*Correspondence: Patrick Vizeli, ; Matthias E. Liechti,
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22
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Behavioral and neural responses during fear conditioning and extinction in a large transdiagnostic sample. Neuroimage Clin 2022; 35:103060. [PMID: 35679785 PMCID: PMC9189200 DOI: 10.1016/j.nicl.2022.103060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/28/2022] [Accepted: 05/21/2022] [Indexed: 11/23/2022]
Abstract
Behavioral and neural responses during Pavlovian fear learning were examined in a large sample of healthy and individuals with anxiety and depression. Latent profile models to threat were derived from behavioral and neural data. Demographic, cognitive, and psychological variables did not robustly characterize latent profiles. Neuroimaging data did not evidence functional role of amygdala in fear learning. Human fear learning recruited a distributed network of regions involved in interoceptive, cognitive, motivational, and psychomotor processes.
Background Dysregulation of fear learning has been associated with psychiatric disorders that have altered positive and negative valence domain function. While amygdala-insula-prefrontal circuitry is considered important for fear learning, there have been inconsistencies in neural findings in healthy and clinical human samples. This study aimed to delineate the neural substrates and behavioral responses during fear learning in a large, transdiagnostic sample with predominantly depressive and/or anxious dysfunction. Methods Two-hundred and eighty-two individuals (52 healthy participants; 230 participants with depression and/or anxiety-related problems) from the Tulsa 1000 study, an ongoing, naturalistic longitudinal study based on a dimensional psychopathological framework, completed a Pavlovian fear learning task during functional magnetic resonance imaging. Linear mixed-effects analyses examined condition-by-time effects on brain activation (CS+, CS- across familiarization, conditioning, and extinction trials). A data-driven latent profile analysis (LPA) examined distinct patterns of behavioral and neural responses to threat across fear conditioning and extinction, while logistic regression analyses evaluated cognitive-affective predictors of latent profiles. Results Whole-brain analyses revealed a condition-by-time interaction in the anterior insula, postcentral gyrus, superior temporal gyrus, middle frontal gyrus, and cerebellum but not amygdala. The LPA identified distinct latent profiles across subjective and neural levels of measurement. Anterior insula profiles were characterized by marginal differences in age and state anxiety. Conclusions Our findings demonstrate that human fear learning recruits a distributed network of regions involved in interoceptive, cognitive, motivational, and psychomotor processes. Data-driven analyses identified distinct profiles of subjective and neural responses during fear learning that transcended clinical diagnoses, but no robust relationships to demographic or cognitive-affective variable were identified.
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23
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Roesmann K, Toelle J, Leehr EJ, Wessing I, Böhnlein J, Seeger F, Schwarzmeier H, Siminski N, Herrmann MJ, Dannlowski U, Lueken U, Klucken T, Straube T, Junghöfer M. Neural correlates of fear conditioning are associated with treatment-outcomes to behavioral exposure in spider phobia - Evidence from magnetoencephalography. Neuroimage Clin 2022; 35:103046. [PMID: 35609411 PMCID: PMC9125677 DOI: 10.1016/j.nicl.2022.103046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/02/2022]
Abstract
Magnetoencephalographic effects of fear conditioning predict exposure outcomes. No associations between fear ratings of conditioned stimuli and exposure outcomes. Prefrontal correlates of safety processing and/or fear inhibition are treatment-relevant. Individual neural differences might be a promising predictor of exposure success.
Background Models of anxiety disorders and the rationale of exposure therapy (ET) are grounded on classical fear conditioning. Yet, it is unclear whether lower fear ratings of conditioned safety versus threat cues and corresponding neural markers of safety-learning and/or fear inhibition assessed before treatment would predict better outcomes of behavioral exposure. Methods Sixty-six patients with spider phobia completed pre-treatment clinical and experimental fear conditioning assessments, one session of virtual reality ET, a post-treatment clinical assessment, and a 6-month follow-up assessment. Tilted Gabor gratings served as conditioned stimuli (CS) that were either paired (CS+) or remained unpaired (CS-) with an aversive phobia-related and phobia-unrelated unconditioned stimulus (UCS). CS+/CS- differences in fear ratings and magnetoencephalographic event-related fields (ERFs) were related to percentual symptom reductions from pre- to post-treatment, as assessed via spider phobia questionnaire (SPQ), behavioral avoidance test (BAT), and remission status at 6-month follow-up. Results We observed no associations between pre-treatment CS+/CS- differences in fear ratings and any treatment outcome. CS+/CS- differences in source estimations of ERFs revealed that higher CS- activity in bilateral dorsolateral prefrontal cortex (dlPFC) was related with SPQ- and BAT-reductions. Associations between CS+/CS- differences and treatment outcomes were also observed in left ventromedial prefrontal cortex (vmPFC) regions, which additionally revealed associations with the follow-up remission status. Conclusions Results provide initial evidence that neural pre-treatment CS+/CS- differences may hold predictive information regarding outcomes of behavioral exposure. Our findings highlight a key role of neural responses to safety cues with potentially inhibitory effects on affect-generating structures during fear conditioning.
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Affiliation(s)
- Kati Roesmann
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany.
| | - Julius Toelle
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany
| | | | - Ida Wessing
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany; Department of Child and Adolescent Psychiatry, University of Münster, Germany
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Fabian Seeger
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany; Department of General Psychiatry, University of Heidelberg, Germany
| | - Hanna Schwarzmeier
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Niklas Siminski
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Martin J Herrmann
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Ulrike Lueken
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - Tim Klucken
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany
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24
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Adams TG, Cisler JM, Kelmendi B, George JR, Kichuk SA, Averill CL, Anticevic A, Abdallah CG, Pittenger C. Transcranial direct current stimulation targeting the medial prefrontal cortex modulates functional connectivity and enhances safety learning in obsessive-compulsive disorder: Results from two pilot studies. Depress Anxiety 2022; 39:37-48. [PMID: 34464485 PMCID: PMC8732293 DOI: 10.1002/da.23212] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Exposed-based psychotherapy is a mainstay of treatment for obsessive-compulsive disorder (OCD) and anxious psychopathology. The medial prefrontal cortex (mPFC) and the default mode network (DMN), which is anchored by the mPFC, promote safety learning. Neuromodulation targeting the mPFC might augment therapeutic safety learning and enhance response to exposure-based therapies. METHODS To characterize the effects of mPFC neuromodulation on functional connectivity, 17 community volunteers completed resting-state functional magnetic resonance imaging scans before and after 20 min of frontopolar anodal multifocal transcranial direct current stimulation (tDCS). To examine the effects of tDCS on therapeutic safety learning, 24 patients with OCD completed a pilot randomized clinical trial; they were randomly assigned (double-blind, 50:50) to receive active or sham frontopolar tDCS before completing an in vivo exposure and response prevention (ERP) challenge. Changes in subjective emotional distress during the ERP challenge were used to index therapeutic safety learning. RESULTS In community volunteers, frontal pole functional connectivity with the middle and superior frontal gyri increased, while connectivity with the anterior insula and basal ganglia decreased (ps < .001, corrected) after tDCS; functional connectivity between DMN and salience network also decreased after tDCS (ps < .001, corrected). OCD patients who received active tDCS exhibited more rapid therapeutic safety learning (ps < .05) during the ERP challenge than patients who received sham tDCS. CONCLUSIONS Frontopolar tDCS may modulate mPFC and DMN functional connectivity and can accelerate therapeutic safety learning. Though limited by small samples, these findings motivate further exploration of the effects of frontopolar tDCS on neural and behavioral targets associated with exposure-based psychotherapies.
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Affiliation(s)
- Thomas G Adams
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
| | - Josh M Cisler
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin, USA
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Benjamin Kelmendi
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
| | - Jamilah R George
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Department of Psychological Sciences, University of Connecticut, Mansfield, Connecticut, USA
| | - Stephen A Kichuk
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Christopher L Averill
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Alan Anticevic
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Chadi G Abdallah
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, Yale University, New Haven, Connecticut, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher Pittenger
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Child Study Center, Yale University, New Haven, Connecticut, USA
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25
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Eder-Moreau E, Zhu X, Fisch CT, Bergman M, Neria Y, Helpman L. Neurobiological Alterations in Females With PTSD: A Systematic Review. Front Psychiatry 2022; 13:862476. [PMID: 35770056 PMCID: PMC9234306 DOI: 10.3389/fpsyt.2022.862476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Most females experience at least one traumatic event in their lives, but not all develop PTSD. Despite considerable research, our understanding of the key factors that constitute risk for PTSD among females is limited. Previous research has largely focused on sex differences, neglecting within group comparisons, thereby obviating differences between females who do and do not develop PTSD following exposure to trauma. In this systematic review, we conducted a search for the extent of existing research utilizing magnetic resonance imaging (MRI) to examine neurobiological differences among females of all ages, with and without PTSD. Only studies of females who met full diagnostic criteria for PTSD were included. Fifty-six studies were selected and reviewed. We synthesized here findings from structural MRI (sMRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and resting state functional connectivity (rs-FC MRI) studies, comparing females with and without PTSD. A range of biopsychosocial constructs that may leave females vulnerable to PTSD were discussed. First, the ways timing and type of exposure to trauma may impact PTSD risk were discussed. Second, the key role that cognitive and behavioral mechanisms may play in PTSD was described, including rumination, and deficient fear extinction. Third, the role of specific symptom patterns and common comorbidities in female-specific PTSD was described, as well as sex-specific implications on treatment and parenting outcomes. We concluded by identifying areas for future research, to address the need to better understand developmental aspects of brain alterations, the differential impact of trauma types and timing, the putative role of neuroendocrine system in neurobiology of PTSD among females, and the impact of social and cultural factors on neurobiology in females with PTSD.
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Affiliation(s)
- Elizabeth Eder-Moreau
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Xi Zhu
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Chana T Fisch
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Maja Bergman
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Yuval Neria
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Liat Helpman
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel.,Psychiatric Research Unit, Tel Aviv Medical Center, Tel Aviv, Israel
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26
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Vargas LDS, Lima KR, Mello-Carpes PB. Infralimbic and prelimbic prefrontal cortex activation is necessary to the enhancement of aversive memory extinction promoted by reactivation. Brain Res 2021; 1770:147630. [PMID: 34450117 DOI: 10.1016/j.brainres.2021.147630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/02/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
Memory extinction has been used in behavioral therapy to treat post-traumatic stress disorders. It was demonstrated that memory reactivation before extinction could facilitate this process. However, the mechanisms involved are still unclear. Here, we investigated the participation of two regions of the ventromedial prefrontal cortex (vmPFC), the infralimbic (IL) and prelimbic (PL), in the memory reactivation modulatory effect of fear extinction. We confirmed that the reactivation facilitates the fear extinction in an inhibitory aversive task; however, when the muscimol (a GABAergic agonist) is infused in IL or PL vmPFC after reactivation, extinction's facilitation was not observed. These findings support the idea that the reactivation can modulate the fear extinction process, facilitating it, and that this effect requires the activation of both IL and PL regions of vmPFC.
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Affiliation(s)
| | - Karine Ramires Lima
- Physiology Research Group, Federal University of Pampa, Uruguaiana, RS, Brazil
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27
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Clinical predictors of treatment response towards exposure therapy in virtuo in spider phobia: A machine learning and external cross-validation approach. J Anxiety Disord 2021; 83:102448. [PMID: 34298236 DOI: 10.1016/j.janxdis.2021.102448] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/07/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
While being highly effective on average, exposure-based treatments are not equally effective in all patients. The a priori identification of patients with a poor prognosis may enable the application of more personalized psychotherapeutic interventions. We aimed at identifying sociodemographic and clinical pre-treatment predictors for treatment response in spider phobia (SP). N = 174 patients with SP underwent a highly standardized virtual reality exposure therapy (VRET) at two independent sites. Analyses on group-level were used to test the efficacy. We applied a state-of-the-art machine learning protocol (Random Forests) to evaluate the predictive utility of clinical and sociodemographic predictors for a priori identification of individual treatment response assessed directly after treatment and at 6-month follow-up. The reliability and generalizability of predictive models was tested via external cross-validation. Our study shows that one session of VRET is highly effective on a group-level and is among the first to reveal long-term stability of this treatment effect. Individual short-term symptom reductions could be predicted above chance, but accuracies dropped to non-significance in our between-site prediction and for predictions of long-term outcomes. With performance metrics hardly exceeding chance level and the lack of generalizability in the employed between-site replication approach, our study suggests limited clinical utility of clinical and sociodemographic predictors. Predictive models including multimodal predictors may be more promising.
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28
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Esser R, Korn CW, Ganzer F, Haaker J. L-DOPA modulates activity in the vmPFC, nucleus accumbens, and VTA during threat extinction learning in humans. eLife 2021; 10:65280. [PMID: 34473055 PMCID: PMC8443250 DOI: 10.7554/elife.65280] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/01/2021] [Indexed: 12/26/2022] Open
Abstract
Learning to be safe is central for adaptive behaviour when threats are no longer present. Detecting the absence of an expected threat is key for threat extinction learning and an essential process for the behavioural treatment of anxiety-related disorders. One possible mechanism underlying extinction learning is a dopaminergic mismatch signal that encodes the absence of an expected threat. Here we show that such a dopamine-related pathway underlies extinction learning in humans. Dopaminergic enhancement via administration of L-DOPA (vs. Placebo) was associated with reduced retention of differential psychophysiological threat responses at later test, which was mediated by activity in the ventromedial prefrontal cortex that was specific to extinction learning. L-DOPA administration enhanced signals at the time-point of an expected, but omitted threat in extinction learning within the nucleus accumbens, which were functionally coupled with the ventral tegmental area and the amygdala. Computational modelling of threat expectancies further revealed prediction error encoding in nucleus accumbens that was reduced when L-DOPA was administered. Our results thereby provide evidence that extinction learning is influenced by L-DOPA and provide a mechanistic perspective to augment extinction learning by dopaminergic enhancement in humans.
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Affiliation(s)
- Roland Esser
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph W Korn
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Section Social Neuroscience, Department of General Psychiatry, Heidelberg, Germany
| | - Florian Ganzer
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Addiction Research in Childhood and Adolescence, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Haaker
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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29
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Roesmann K, Leehr EJ, Böhnlein J, Steinberg C, Seeger F, Schwarzmeier H, Gathmann B, Siminski N, Herrmann MJ, Dannlowski U, Lueken U, Klucken T, Hilbert K, Straube T, Junghöfer M. Behavioral and Magnetoencephalographic Correlates of Fear Generalization are Associated with Responses to Later Virtual Reality Exposure Therapy in Spider Phobia. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:221-230. [PMID: 34325047 DOI: 10.1016/j.bpsc.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/25/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND As overgeneralization of fear is a pathogenic marker of anxiety disorders, we investigated whether pre-treatment levels of fear generalization in spider-phobic patients are related to their response to exposure-based treatment, in order to identify pre-treatment moderators of treatment success. METHODS Ninety patients with spider phobia completed pre-treatment clinical and magnetoencephalography (MEG) assessments, one session of virtual reality exposure therapy, and a post-treatment clinical assessment. Based on the primary outcome (30% symptom reduction in self-reported symptoms) they were categorized as responders or non-responders. In a pre-treatment MEG fear generalization paradigm involving fear conditioning with two unconditioned stimuli (UCS), we obtained fear ratings, UCS-expectancy ratings, and event-related fields to conditioned stimuli (CS-, CS+) and 7 different generalization stimuli (GS) on a perceptual continuum from CS- to CS+. RESULTS Prior to treatment, non-responders showed behavioral overgeneralization indicated by more linear generalization gradients in fear ratings. Analyses of MEG source estimations revealed that non-responders showed a decline of their (inhibitory) frontal activations to safety-signaling CS- and GS compared to CS+ over time, while responders maintained these activations at early (<300ms) and late processing stages. CONCLUSIONS Results provide initial evidence that pre-treatment differences of behavioral and neural markers of fear generalization may act as moderators of later responses to behavioral exposure. Stimulating further research on fear generalization as a potential predictive marker, our findings are an important first step in the attempt to identify patients who may not profit from ET, and to personalize and optimize treatment strategies for this vulnerable patient group.
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Affiliation(s)
- Kati Roesmann
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany; Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany.
| | - Elisabeth Johanna Leehr
- Institute for Translational Psychiatry, University of Münster, Albert Schweitzer-Campus 1, G 9A, 48149 Münster, Germany
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Albert Schweitzer-Campus 1, G 9A, 48149 Münster, Germany
| | - Christian Steinberg
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany
| | - Fabian Seeger
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Hanna Schwarzmeier
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Niklas Siminski
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Martin J Herrmann
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Albert Schweitzer-Campus 1, G 9A, 48149 Münster, Germany
| | - Ulrike Lueken
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - Tim Klucken
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany
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30
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Cano M, Martínez-Zalacaín I, Giménez M, Torrents-Rodas D, Real E, Alonso P, Segalàs C, Munuera J, Menchón JM, Cardoner N, Soriano-Mas C, Fullana MA. Neural correlates of fear conditioning and fear extinction and its association with cognitive-behavioral therapy outcome in adults with obsessive-compulsive disorder. Behav Res Ther 2021; 144:103927. [PMID: 34237645 DOI: 10.1016/j.brat.2021.103927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
Recent neurobiological models of obsessive-compulsive disorder (OCD) have highlighted the potential role of abnormalities in fear learning processes. We compared brain activation -as assessed with whole-brain functional magnetic resonance imaging- during fear conditioning, fear extinction learning, and fear extinction recall in patients with OCD (n = 18) and healthy controls (n = 18). We also investigated whether brain activation during any of these processes was associated with exposure-based cognitive-behavioral therapy (CBT) outcome in patients. Patients with OCD showed significantly lower brain activation in the right insulo-opercular region and the dorsal anterior cingulate cortex during fear conditioning in comparison to healthy controls. Moreover, brain activation in the right insula predicted CBT outcome, with lower activation predicting a better outcome. Brain activation during extinction learning or recall did not differ between patients and controls or predicted CBT outcome in patients. Our results suggest that neural activations during fear conditioning in patients with OCD are abnormal and predict CBT outcome.
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Affiliation(s)
- Marta Cano
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d'Investigació i Innovació Sanitària Parc Tauli (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Carlos III Health Institute, Sabadell, Spain; Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Mònica Giménez
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain
| | | | - Eva Real
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain
| | - Pino Alonso
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain
| | - Cinto Segalàs
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain
| | - Josep Munuera
- Diagnostic Imaging Department, Fundació de Recerca Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - José Manuel Menchón
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Narcís Cardoner
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d'Investigació i Innovació Sanitària Parc Tauli (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Carlos III Health Institute, Sabadell, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Carles Soriano-Mas
- Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Bellvitge University Hospital, and CIBERSAM, Carlos III Health Institute, L'Hospitalet de Llobregat, Spain.
| | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain.
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Ressler KJ. Translating Across Circuits and Genetics Toward Progress in Fear- and Anxiety-Related Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:247-255. [PMID: 34690590 PMCID: PMC8475910 DOI: 10.1176/appi.focus.19205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 06/13/2023]
Abstract
(Reprinted with permission from Am J Psychiatry 2020; 177:214-222).
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32
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Scheveneels S, Boddez Y, Hermans D. Predicting clinical outcomes via human fear conditioning: A narrative review. Behav Res Ther 2021; 142:103870. [PMID: 34000680 DOI: 10.1016/j.brat.2021.103870] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
A common assumption in human fear conditioning research is that findings are informative for the etiology and treatment of clinical anxiety. One way to empirically evaluate the external validity of fear conditioning is by prospective studies. We review available prospective research investigating whether individual performance in fear conditioning predicts individual differences in anxiety levels and exposure-based treatment outcome. We focus on fear extinction, generalization, acquisition, and avoidance. Results suggest that reduced extinction and broader generalization predict higher anxiety levels. Results with respect to the predictive value of acquisition for anxiety levels are mixed. With regard to predicting exposure-based treatment outcome, some studies do find an association with extinction whereas others do not. The majority of studies does not find an association with acquisition. Evidence on extinction recall is limited and not consistent. The interpretation of these results requires caution. The number of available studies is limited. It is possible that not all work, in particular studies with only null effects, has found its way to publication. Future research on this topic will benefit from large sample sizes, preregistered hypotheses, full transparency about the conducted analyses and the publication of high-quality studies with null effects.
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Affiliation(s)
- Sara Scheveneels
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium.
| | - Yannick Boddez
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Dirk Hermans
- Center for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
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33
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Lamoureux-Tremblay V, Chauret M, Muckle G, Maheu F, Suffren S, Jacobson SW, Jacobson JL, Ayotte P, Lepore F, Saint-Amour D. Altered functional activations of prefrontal brain areas during emotional processing of fear in Inuit adolescents exposed to environmental contaminants. Neurotoxicol Teratol 2021; 85:106973. [PMID: 33741477 PMCID: PMC8137647 DOI: 10.1016/j.ntt.2021.106973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/16/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Exposure to mercury, lead and polychlorinated biphenyls (PCBs) have been associated with emotional dysregulation, but their neuronal correlates have yet to be examined. Inuit from Nunavik (Northern Quebec, Canada) face internalizing problems and are among the most exposed individuals to these environmental contaminants in the world. The aim of this study was to examine the link between pre- and postnatal exposure to these contaminants and brain fear-circuitry in Inuit adolescents. Facial expression stimuli were presented to participants (mean age = 18.3 years) in a magnetic resonance imaging (MRI) scanner. Fear conditioning and extinction tasks included neutral faces as the conditioned threat and safety cues and a fearful face paired with a shrieking scream as the unconditioned stimulus. Functional MRI data were gathered at the conditioning phase (n = 71) and at the extinction phase (n = 62). Mercury, lead and PCB 153 concentrations were measured in blood samples at birth (cord blood) and at the time of the adolescent testing to estimate pre- and postnatal exposure, respectively. For each time point, exposures were categorized in tertiles (low, moderate and high exposed groups). Mixed analyses of variance were conducted for each contaminant of interest controlling for sex, age, socioeconomic status, drug/alcohol use, food insecurity and contaminant co-exposure. Results revealed greater differential activation during the conditioning phase in the right orbitofrontal cortex in participants with moderate and high concentrations of cord blood PCB 153 compared to those in the low exposure group. During the extinction phase, the high prenatal mercury exposed group showed a lower differential activation in the right and left anterior cingulate cortex compared to those in the low-exposed group; whereas there was a higher differential activation in right dorsolateral prefrontal cortex in the high postnatal lead exposed group compared to the moderate- and low-exposed groups. Our study is the first to show alterations in the prefrontal brain areas in fear conditioning and extinction tasks in relation to environmental contaminant exposures. The observed brain correlates may advance our understanding of the emotional problems associated with environmental chemical toxicity.
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Affiliation(s)
| | - Mélissa Chauret
- Département de Psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Gina Muckle
- Centre de Recherche du CHUQ de Québec-Université Laval, École de Psychologie, Université Laval, Québec, Québec, Canada
| | - Françoise Maheu
- Research Centre of CHU Ste-Justine, Montréal, Québec, Canada
| | - Sabrina Suffren
- Research Centre of CHU Ste-Justine, Montréal, Québec, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, United States
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI 48201, United States
| | - Pierre Ayotte
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Franco Lepore
- Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Dave Saint-Amour
- Département de Psychologie, Université du Québec à Montréal, Montréal, Québec, Canada; Research Centre of CHU Ste-Justine, Montréal, Québec, Canada.
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34
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Fritz EM, Kreuzer M, Altunkaya A, Singewald N, Fenzl T. Altered sleep behavior in a genetic mouse model of impaired fear extinction. Sci Rep 2021; 11:8978. [PMID: 33903668 PMCID: PMC8076259 DOI: 10.1038/s41598-021-88475-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/13/2021] [Indexed: 02/03/2023] Open
Abstract
Sleep disturbances are a common complaint of anxiety patients and constitute a hallmark feature of post-traumatic stress disorder (PTSD). Emerging evidence suggests that poor sleep is not only a secondary symptom of anxiety- and trauma-related disorders but represents a risk factor in their development, for example by interfering with emotional memory processing. Fear extinction is a critical mechanism for the attenuation of fearful and traumatic memories and multiple studies suggest that healthy sleep is crucial for the formation of extinction memories. However, fear extinction is often impaired in anxiety- and trauma-related disorders-an endophenotype that is perfectly modelled in the 129S1/SvImJ inbred mouse strain. To investigate whether these mice exhibit altered sleep at baseline that could predispose them towards maladaptive fear processing, we compared their circadian sleep/wake patterns to those of typically extinction-competent C57BL/6 mice. We found significant differences regarding diurnal distribution of sleep and wakefulness, but also sleep architecture, spectral features and sleep spindle events. With regard to sleep disturbances reported by anxiety- and PTSD patients, our findings strengthen the 129S1/SvImJ mouse models' face validity and highlight it as a platform to investigate novel, sleep-focused diagnostic and therapeutic strategies. Whether the identified alterations causally contribute to its pathological anxiety/PTSD-like phenotype will, however, have to be addressed in future studies.
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Affiliation(s)
- Eva Maria Fritz
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Innsbruck, Austria
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alp Altunkaya
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Innsbruck, Austria
| | - Thomas Fenzl
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Innsbruck, Austria.
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
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35
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Intrusive memories as conditioned responses to trauma cues: An empirically supported concept? Behav Res Ther 2021; 143:103848. [PMID: 34091275 DOI: 10.1016/j.brat.2021.103848] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/11/2021] [Accepted: 03/15/2021] [Indexed: 01/19/2023]
Abstract
Intrusions in posttraumatic stress disorder (PTSD) are clinically understood as conditioned responses (CRs) to trauma-cues; however, experimental evidence for this is limited. We subjected 84 healthy participants to a differential conditioned-intrusion paradigm, where neutral faces served as conditioned stimuli (CSs) and aversive film clips as unconditioned stimuli (USs). While one group only completed acquisition, another group additionally received extinction. Subsequently, participants provided detailed e-diary intrusion reports. Several key findings emerged: First, participants in both groups re-experienced not only USs but also CSs as content of their intrusions. Second, intrusions were elicited by cues resembling CSs, USs, and experimental context. Third, extinction reduced probability and severity of US intrusions, and accelerated their decay, and this was particularly the case in participants showing greater cognitive (US-expectancy) and physiological (SCR) differential responding to CS+ vs. CS- at end of acquisition (i.e., conditionability). Similarly, extinction reduced CS-intrusion probability and severity, but only in participants with greater cognitive conditionability. These results support conditioning's role in re-experiencing in two critical ways: (1) Conditioning during trauma provides cues that not only function as reminder cues, but also as content of intrusions; (2) After strong conditioning, weakening the original CS-US relationship via extinction reduces intrusion formation after analogue-trauma.
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36
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The effects of FAAH inhibition on the neural basis of anxiety-related processing in healthy male subjects: a randomized clinical trial. Neuropsychopharmacology 2021; 46:1011-1019. [PMID: 33335310 PMCID: PMC8105363 DOI: 10.1038/s41386-020-00936-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/05/2020] [Accepted: 11/30/2020] [Indexed: 12/21/2022]
Abstract
Acute pharmacological inhibition of the anandamide-degrading enzyme, fatty acid amide hydrolase (FAAH), prolongs the regulatory effects of endocannabinoids and reverses the stress-induced anxiety state in a cannabinoid receptor-dependent manner. However, the neural systems underlying this modulation are poorly understood. A single site, randomized, double-blind, placebo-controlled, parallel study was conducted with 43 subjects assigned to receive once daily dosing of either placebo (n = 21) or JNJ-42165279 (100 mg) (n = 22) for 4 consecutive days. Pharmacodynamic effects were assessed on the last day of dosing and included evaluation of brain activation patterns using BOLD fMRI during an (1) emotion face-processing task, (2) inspiratory breathing load task, and (3) fear conditioning and extinction task. JNJ-42165279 attenuated activation in the amygdala, bilateral anterior cingulate, and bilateral insula during the emotion face-processing task consistent with effects previously observed with anxiolytic agents. Higher levels of anandamide were associated with greater attenuation in bilateral anterior cingulate and left insula. JNJ-42165279 increased the activation during anticipation of an aversive interoceptive event in the anterior cingulate and bilateral anterior insula and right inferior frontal cortex. JNJ-42165279 did not affect fear conditioning or within-session extinction learning as evidenced by a lack of differences on a subjective and neural circuit level. Taken together, these results support the hypothesis that JNJ-42165279 at this dose shares some effects with existing anxiolytic agents in dampening response to emotional stimuli but not responses to conditioned fear.
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37
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Fear extinction learning and anandamide: an fMRI study in healthy humans. Transl Psychiatry 2021; 11:161. [PMID: 33723207 PMCID: PMC7961038 DOI: 10.1038/s41398-020-01177-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Anxiety- and trauma-related disorders are severe illnesses with high prevalence. Current treatment options leave room for improvement and the endocannabinoid system (ECS) has become a key target in psychopharmacological research. Rodent models suggest an anxiolytic effect of endocannabinoids and demonstrated that the ECS is involved in the modulation of fear learning and aversive memory consolidation. So far, one prominent target was inhibition of fatty acid amino hydrolase (FAAH), the degrading enzyme of the endocannabinoid anandamide (AEA). Research in humans remains scarce, but genetic studies have found that the single-nucleotide polymorphism (SNP) FAAH C385A (rs324420) is associated with lower catabolic performance of FAAH and increased levels of AEA. Translational research on the ECS in fear learning processes is rare, yet crucial to understand the mechanisms involved. To address this lack of research, we designed a fear conditioning, extinction learning paradigm with 51 healthy, male humans who underwent functional magnetic resonance imaging (fMRI) before analysing baseline and task-related changes of AEA, as well as the FAAH polymorphism (rs324420). The results indicate higher AEA levels in AC-heterozygotes than in CC-individuals (SNP rs324420), but no difference between the groups during extinction learning. However, neural activation of the anterior cingulate cortex and anterior insular cortex during extinction learning correlated positively with AEA baseline levels, and task-related changes in AEA were found particularly during fear extinction, with a modulatory effect on neural activation related to extinction learning. Results indicate a putative role for AEA in fear extinction learning. Pre-treatment with AEA-enhancing drugs could promote extinction learning during psychotherapeutic interventions.
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38
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Duits P, Baas JMP, Engelhard IM, Richter J, Huisman-van Dijk HM, Limberg-Thiesen A, Heitland I, Hamm AO, Cath DC. Latent class growth analyses reveal overrepresentation of dysfunctional fear conditioning trajectories in patients with anxiety-related disorders compared to controls. J Anxiety Disord 2021; 78:102361. [PMID: 33508747 DOI: 10.1016/j.janxdis.2021.102361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
Recent meta-analyses indicated differences in fear acquisition and extinction between patients with anxiety-related disorders and comparison subjects. However, these effects are small and may hold for only a subsample of patients. To investigate individual trajectories in fear acquisition and extinction across patients with anxiety-related disorders (N = 104; before treatment) and comparison subjects (N = 93), data from a previous study (Duits et al., 2017) were re-analyzed using data-driven latent class growth analyses. In this explorative study, subjective fear ratings, shock expectancy ratings and startle responses were used as outcome measures. Fear and expectancy ratings, but not startle data, yielded distinct fear conditioning trajectories across participants. Patients were, compared to controls, overrepresented in two distinct dysfunctional fear conditioning trajectories: impaired safety learning and poor fear extinction to danger cues. The profiling of individual patterns allowed to determine that whereas a subset of patients showed trajectories of dysfunctional fear conditioning, a significant proportion of patients (≥50 %) did not. The strength of trajectory analyses as opposed to group analyses is that it allows the identification of individuals with dysfunctional fear conditioning. Results suggested that dysfunctional fear learning may also be associated with poor treatment outcome, but further research in larger samples is needed to address this question.
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Affiliation(s)
- Puck Duits
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Center, Utrecht, The Netherlands.
| | - Johanna M P Baas
- Department of Experimental Psychology and Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Center, Utrecht, The Netherlands.
| | - Jan Richter
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | | | - Anke Limberg-Thiesen
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | - Ivo Heitland
- Department of Experimental Psychology and Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany.
| | - Danielle C Cath
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Center, Utrecht, The Netherlands; Department of Psychiatry, University Medical Center Groningen and University of Groningen, GGZ Drenthe, Department of Specialist Training, The Netherlands.
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39
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Laing PA, Vervliet B, Fullana MA, Savage HS, Davey CG, Felmingham KL, Harrison BJ. Characterizing human safety learning via Pavlovian conditioned inhibition. Behav Res Ther 2021; 137:103800. [DOI: 10.1016/j.brat.2020.103800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 02/08/2023]
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40
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Manthey A, Sierk A, Brakemeier EL, Walter H, Daniels JK. Does trauma-focused psychotherapy change the brain? A systematic review of neural correlates of therapeutic gains in PTSD. Eur J Psychotraumatol 2021; 12:1929025. [PMID: 34394855 PMCID: PMC8354020 DOI: 10.1080/20008198.2021.1929025] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Meta-analytic results indicate that posttraumatic stress disorder (PTSD) is associated with hypoactivation of the medial prefrontal cortex (mPFC), hyperactivation of the amygdala, and volume reductions of the hippocampus. Effective psychotherapeutic treatments were hypothesized to normalize these neural patterns via upregulation of prefrontal structures, which in turn downregulate limbic regions. OBJECTIVE To gain a sound understanding of the effects of successful psychotherapy on the brain, neural changes from pre- to post-treatment in PTSD patients will be aggregated. METHOD A systematic literature search identified 24 original studies employing structural or functional MRI measurements both before and after treatment of patients diagnosed with PTSD. RESULTS In conjunction, the review returned little evidence of an activation increase in the mPFC/rostral anterior cingulate cortex (rACC) following successful treatment. Five out of 12 studies observed such an increase (especially during emotion processing tasks), albeit in partially non-overlapping brain regions. Conversely, neither the putative related activation decrease in the amygdala nor volumetric changes or altered activation during the resting state could be convincingly established. CONCLUSION Successful psychological treatments might potentially work via upregulation of the mPFC, which thus may be involved in symptom reduction. However, the role of the amygdala in recovery from PTSD remains unclear. There is currently no indication that the various PTSD treatment approaches employed by the reviewed studies differ regarding their action mechanisms, but further research on this topic is needed.
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Affiliation(s)
- Antje Manthey
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anika Sierk
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Universität Greifswald, Greifswald, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith K Daniels
- Psychologische Hochschule Berlin, Berlin, Germany.,Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
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41
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Savage HS, Davey CG, Fullana MA, Harrison BJ. Threat and safety reversal learning in social anxiety disorder - an fMRI study. J Anxiety Disord 2020; 76:102321. [PMID: 33099070 DOI: 10.1016/j.janxdis.2020.102321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/14/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
Social anxiety disorder (SAD) has been linked to maladaptive forms of fear regulation, including flexibly distinguishing between learned threat and safety signals. Few studies have examined this in young, unmedicated SAD patients, including its neural basis. We aimed to characterize the neural, subjective, and autonomic correlates of reversal learning in patients with SAD and compare them to matched patients with major depressive disorder and to healthy control participants. All participants completed a threat-safety reversal learning task during functional magnetic resonance imaging. Successful threat-safety updating was associated with significant activation of primary regions of interest (anterior cingulate, insula and ventromedial prefrontal cortex), however, no significant differences were observed between them, consistent with subjective reports of task-evoked anxiety and affect. Contrary to expectations, we did not observe threat and safety reversal learning to be significantly impaired in young people with SAD.
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Affiliation(s)
- Hannah S Savage
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, VIC, Australia.
| | | | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, VIC, Australia.
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42
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Giménez M, Cano M, Martínez-Zalacaín I, Real E, Alonso P, Segalàs C, Munuera J, Kegeles LS, Weinstein JJ, Xu X, Menchón JM, Cardoner N, Soriano-Mas C, Fullana MA. Is glutamate associated with fear extinction and cognitive behavior therapy outcome in OCD? A pilot study. Eur Arch Psychiatry Clin Neurosci 2020; 270:1003-1014. [PMID: 31432262 DOI: 10.1007/s00406-019-01056-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/07/2019] [Indexed: 12/15/2022]
Abstract
Cognitive behavioral therapy (CBT) including exposure and response prevention is a well-established treatment for obsessive-compulsive disorder (OCD) and is based on the principles of fear extinction. Fear extinction is linked to structural and functional variability in the ventromedial prefrontal cortex (vmPFC) and has been consistently associated with glutamate neurotransmission. The relationship between vmPFC glutamate and fear extinction and its effects on CBT outcome have not yet been explored in adults with OCD. We assessed glutamate levels in the vmPFC using 3T magnetic resonance spectroscopy, and fear extinction (learning and recall) using skin conductance responses during a 2-day experimental paradigm in OCD patients (n = 17) and in healthy controls (HC; n = 13). Obsessive-compulsive patients (n = 12) then received manualized CBT. Glutamate in the vmPFC was negatively associated with fear extinction recall and positively associated with CBT outcome (with higher glutamate levels predicting a better outcome) in OCD patients. Glutamate levels in the vmPFC in OCD patients were not significantly different from those in HC, and were not associated with OCD severity. Our results suggest that glutamate in the vmPFC is associated with fear extinction recall and CBT outcome in adult OCD patients.
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Affiliation(s)
- M Giménez
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - M Cano
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - I Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - E Real
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - P Alonso
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - C Segalàs
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - J Munuera
- Diagnostic Imaging Department, Fundació de Recerca Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - L S Kegeles
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA
| | - J J Weinstein
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA.,Department of Psychiatry, Stony Brook University, Stony Brook, 101 Nicolls Rd, Stony Brook, New York, 11794, USA
| | - X Xu
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA
| | - J M Menchón
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - N Cardoner
- Depression and Anxiety Program, Department of Mental Health, Parc Taulí Sabadell, Hospital Universitari, Parc Taulí 1, 08208, Sabadell, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193, Cerdanyola Del Vallès Barcelona, Barcelona, Spain
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Building B1, Ca n'Altayó, s/n, Bellaterra, 08193, Barcelona, Spain
| | - M A Fullana
- Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain. .,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193, Cerdanyola Del Vallès Barcelona, Barcelona, Spain. .,Psychiatry Department, Hospital Clínic-Institute of Neurosciences, CIBERSAM, C/Rosselló 140, 08036, Barcelona, Spain.
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Li SH, Graham BM. Progesterone levels predict reductions in behavioral avoidance following cognitive restructuring in women with spider phobia. J Affect Disord 2020; 270:1-8. [PMID: 32275214 DOI: 10.1016/j.jad.2020.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ovarian hormones have been implicated as a potential source of variability in the effectiveness of exposure therapy for anxiety disorders in women. Additionally, preclinical studies in healthy women indicate that ovarian hormones are related to cognitive modes of emotion regulation, like cognitive restructuring. The purpose of the current study was to determine whether a relationship exists between endogenous ovarian hormones and the outcomes of cognitive restructuring in clinically anxious women. METHODS Ninety women with spider phobia received training in cognitive restructuring or a control task and provided a blood sample for the measurement of serum estradiol and progesterone levels. Behavioral avoidance, using a behavioral approach task with a live spider, and self-reported fear of spiders were measured at baseline and 1-week post-treatment. RESULTS The results indicated that heightened levels of progesterone, but not estradiol, at the time of cognitive restructuring predicted greater post-treatment reductions in behavioral avoidance, but not self-reported fear, amongst women who received cognitive restructuring but not those in the control group. LIMITATIONS As menstrual cycle phase was not assessed; the present study provides information regarding how the benefits of cognitive therapy are predicted by between-person individual differences in absolute hormone levels, but does not examine the relationship between within-person fluctuations in hormone levels and outcomes. CONCLUSIONS These results suggest the effectiveness of cognitive therapy for anxiety disorders in women may differ depending on endogenous levels of progesterone, and raise the possibility that progesterone could be a useful pharmacological adjunct to cognitive therapy.
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Affiliation(s)
- Sophie H Li
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, 2052, Australia.
| | - Bronwyn M Graham
- School of Psychology, The University of New South Wales Australia, Sydney, New South Wales, 2052, Australia
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Prospective testing of a neurophysiologic biomarker for treatment decisions in major depressive disorder: The PRISE-MD trial. J Psychiatr Res 2020; 124:159-165. [PMID: 32169689 PMCID: PMC7141143 DOI: 10.1016/j.jpsychires.2020.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/03/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Management of Major Depressive Disorder (MDD) might be improved by a biomarker to predict whether a selected medication is likely to lead to remission. We previously reported on a quantitative electroencephalogram-based biomarker, the Antidepressant Treatment Response (ATR) index, that integrated recordings at baseline and after one week of treatment. The present study prospectively tested whether treatment directed by the biomarker increased the likelihood of remission; we hypothesized that continued treatment with a drug predicted to lead to remission (i.e., high ATR values) would be associated with better outcomes than if the drug was predicted not to lead to remission (i.e., low ATR values). We enrolled 180 adult outpatients with unipolar MDD from the community. After one week of escitalopram treatment to determine the biomarker, stratified randomization (high vs. low ATR) was used to assign subjects to either continued escitalopram or a switch to bupropion as a blinded control condition, for seven additional weeks. For the 73 evaluable subjects assigned to continued escitalopram treatment, the remission rate was significantly higher for those in whom ATR had predicted remission versus non-remission (60.4% vs. 30.0%, respectively, p = 0.01). Accuracy was enhanced by combining 1-week depressive symptom change with ATR (68.6% vs 28.9%). This prospective validation study supports further development of the ATR biomarker, alone or together with early symptom change, to improve care by identifying individuals unlikely to remit with their current treatment, and support the decision to change treatment after one week rather than after failing a full, prolonged course of medication.
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Tang S, Graham BM. Hormonal, reproductive, and behavioural predictors of fear extinction recall in female rats. Horm Behav 2020; 121:104693. [PMID: 31981581 DOI: 10.1016/j.yhbeh.2020.104693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/13/2020] [Accepted: 01/18/2020] [Indexed: 01/09/2023]
Abstract
The prevalence, severity and chronicity of anxiety disorders is significantly higher in women compared to men. Exposure therapy, the gold-standard treatment for anxiety disorders, can be modelled in the laboratory through Pavlovian fear extinction. Understanding the factors that influence fear extinction in females may aid in optimising the treatment of anxiety disorders in this population. The aim of the current study was therefore to explore the hormonal, reproductive and behavioural predictors of fear extinction recall in female rats by analysing data from nine published experiments that examined fear extinction in female rats. A hierarchical multiple regression analysis revealed that estrous cycle effects on extinction recall may be modulated by reproductive status. While the estrous phase in which nulliparous (virgin) rats undergo extinction training was predictive of extinction recall, no relationship between estrous phase and extinction recall was found among primiparous (one prior reproductive experience) rats. Moreover, estrous cycle predicted the relationship between early extinction and extinction recall in nulliparous rats, but not primiparous rats. Although reproductive status did not predict extinction recall, primiparous rats exhibited poor extinction recall relative to nulliparous rats extinguished during proestrus, and better extinction recall than nulliparous rats extinguished during metestrus. A faster rate of extinction, and lower fear responses at the end of extinction training were predictive of lower levels of CS-elicited fear during extinction recall in both nulliparous and primiparous female rats, while the length of extinction training was not predictive of extinction recall. The potential theoretical and clinical implications of these findings are discussed.
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Affiliation(s)
- Samantha Tang
- School of Psychology, UNSW Sydney, NSW 2052, Australia.
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Facilitating translational science in anxiety disorders by adjusting extinction training in the laboratory to exposure-based therapy procedures. Transl Psychiatry 2020; 10:110. [PMID: 32317621 PMCID: PMC7174283 DOI: 10.1038/s41398-020-0786-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022] Open
Abstract
Extinction learning is suggested to be a central mechanism during exposure-based cognitive behavioral psychotherapy. A positive association between the patients' pretreatment extinction learning performance and treatment outcome would corroborate the hypothesis. Indeed, there is first correlational evidence between reduced extinction learning and therapy efficacy. However, the results of these association studies may be hampered by extinction-training protocols that do not match treatment procedures. Therefore, we developed an extinction-training protocol highly tailored to the procedure of exposure therapy and tested it in two samples of 46 subjects in total. By using instructed fear acquisition training, including a consolidation period overnight, we wanted to ensure that the conditioned fear response was well established prior to extinction training, which is the case in patients with anxiety disorders prior to treatment. Moreover, the extinction learning process was analyzed on multiple response levels, comprising unconditioned stimulus (US) expectancy ratings, autonomic responses, defensive brain stem reflexes, and neural activation using functional magnetic resonance imaging. Using this protocol, we found robust fear conditioning and slow-speed extinction learning. We also observed within-group heterogeneity in extinction learning, albeit a stable fear response at the beginning of the extinction training. Finally, we found discordance between different response systems, suggesting that multiple processes are involved in extinction learning. The paradigm presented here might help to ameliorate the association between extinction learning performance assessed in the laboratory and therapy outcomes and thus facilitate translational science in anxiety disorders.
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Bas-Hoogendam JM, Westenberg PM. Imaging the socially-anxious brain: recent advances and future prospects. F1000Res 2020; 9:F1000 Faculty Rev-230. [PMID: 32269760 PMCID: PMC7122428 DOI: 10.12688/f1000research.21214.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Social anxiety disorder (SAD) is serious psychiatric condition with a genetic background. Insight into the neurobiological alterations underlying the disorder is essential to develop effective interventions that could relieve SAD-related suffering. In this expert review, we consider recent neuroimaging work on SAD. First, we focus on new results from magnetic resonance imaging studies dedicated to outlining biomarkers of SAD, including encouraging findings with respect to structural and functional brain alterations associated with the disorder. Furthermore, we highlight innovative studies in the field of neuroprediction and studies that established the effects of treatment on brain characteristics. Next, we describe novel work aimed to delineate endophenotypes of SAD, providing insight into the genetic susceptibility to develop the disorder. Finally, we outline outstanding questions and point out directions for future research.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, c/o LUMC, postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - P. Michiel Westenberg
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, c/o LUMC, postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands
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Bas-Hoogendam JM, van Steenbergen H, van der Wee NJA, Westenberg PM. Amygdala hyperreactivity to faces conditioned with a social-evaluative meaning- a multiplex, multigenerational fMRI study on social anxiety endophenotypes. NEUROIMAGE-CLINICAL 2020; 26:102247. [PMID: 32247196 PMCID: PMC7125356 DOI: 10.1016/j.nicl.2020.102247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 12/31/2022]
Abstract
Social anxiety disorder (SAD) runs in families, but the neurobiological pathways underlying the genetic susceptibility towards SAD are largely unknown. Here, we employed an endophenotype approach, and tested the hypothesis that amygdala hyperreactivity to faces conditioned with a social-evaluative meaning is a candidate SAD endophenotype. We used data from the multiplex, multigenerational Leiden Family Lab study on Social Anxiety Disorder (eight families, n = 105) and investigated amygdala activation during a social-evaluative conditioning paradigm with high ecological validity in the context of SAD. Three neutral faces were repeatedly presented in combination with socially negative, positive or neutral sentences. We focused on two endophenotype criteria: co-segregation of the candidate endophenotype with the disorder within families, and heritability. Analyses of the fMRI data were restricted to the amygdala as a region of interest, and association analyses revealed that bilateral amygdala hyperreactivity in response to the conditioned faces co-segregated with social anxiety (SA; continuous measure) within the families; we found, however, no relationship between SA and brain activation in response to more specific fMRI contrasts. Furthermore, brain activation in a small subset of voxels within these amygdala clusters was at least moderately heritable. Taken together, these findings show that amygdala engagement in response to conditioned faces with a social-evaluative meaning qualifies as a neurobiological candidate endophenotype of social anxiety. Thereby, these data shed light on the genetic vulnerability to develop SAD.
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Affiliation(s)
- Janna Marie Bas-Hoogendam
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Henk van Steenbergen
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - P Michiel Westenberg
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
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Raeder F, Merz CJ, Margraf J, Zlomuzica A. The association between fear extinction, the ability to accomplish exposure and exposure therapy outcome in specific phobia. Sci Rep 2020; 10:4288. [PMID: 32152429 PMCID: PMC7062844 DOI: 10.1038/s41598-020-61004-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/18/2020] [Indexed: 01/01/2023] Open
Abstract
Great interest exists in maximizing exposure therapy efficacy in anxiety disorders. At the same time, reduced frequency and shortened duration of exposure sessions are required to meet the specific regularities in routine care settings. Extinction has emerged as the key mechanism of exposure treatment in anxiety disorders. Examining exposure treatment processes from the perspective of extinction learning might provide novel insights into variability in exposure treatment duration and outcome. The present study sought to examine the functional link between fear extinction, the ability to accomplish exposure in a predetermined time and exposure therapy outcome in specific phobia. Treatment-seeking individuals (N = 53) with spider phobia underwent a context-dependent fear conditioning paradigm prior to a standardized exposure. Spider-phobic participants who were able to complete exposure within the pre-determined time (i.e., completers) showed a more pronounced short- and long-term exposure therapy benefit. In the fear conditioning task, a more pronounced decline in CS-US contingency ratings during extinction (retrieval) was found in completers relative to non-completers. The failure to further extinguish US expectancy to the CSs in non-completers might offer a potential mechanistic explanation why non-completers have difficulties to accomplish all exposure steps in a fixed time and show less pronounced treatment gains. Our findings bear specific implications for the implementation of exposure treatment to routine care settings.
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Affiliation(s)
- Friederike Raeder
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Christian J Merz
- Department of Cognitive Psychology, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Armin Zlomuzica
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany.
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Abstract
Anxiety and fear-related disorders are common and disabling, and they significantly increase risk for suicide and other causes of morbidity and mortality. However, there is tremendous potential for translational neuroscience to advance our understanding of these disorders, leading to novel and powerful interventions and even to preventing their initial development. This overview examines the general circuits and processes thought to underlie fear and anxiety, along with the promise of translational research. It then examines some of the data-driven "next-generation" approaches that are needed for discovery and understanding but that do not always fit neatly into established models. From one perspective, these disorders offer among the most tractable problems in psychiatry, with a great deal of accumulated understanding, across species, of neurocircuit, behavioral, and, increasingly, genetic mechanisms, of how dysregulation of fear and threat processes contributes to anxiety-related disorders. One example is the progressively sophisticated understanding of how extinction underlies the exposure therapy component of cognitive-behavioral therapy approaches, which are ubiquitously used across anxiety and fear-related disorders. However, it is also critical to examine gaps in our understanding between reasonably well-replicated examples of successful translation, areas of significant deficits in knowledge, and the role of large-scale data-driven approaches in future progress and discovery. Although a tremendous amount of progress is still needed, translational approaches to understanding, treating, and even preventing anxiety and fear-related disorders offer great opportunities for successfully bridging neuroscience discovery to clinical practice.
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